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Morin C, Doray B, Dumar C, Balit J, Bouscaren N, Spodenkiewicz M. Qualitative study of the lived experience of methylphenidate prescribed for children with a fetal alcohol spectrum disorder. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02457-z. [PMID: 38755318 DOI: 10.1007/s00787-024-02457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) refer to physical, cognitive, and behavioural symptoms in an individual whose mother consumed alcohol during pregnancy. It is the leading cause of non-genetic avoidable mental disability, with an estimated worldwide prevalence of 1%. Attention Deficit Hyperactivity Disorder (ADHD) diagnostic criteria are met for 50-80% of patients with FASD. Methylphenidate (MPH) is the first-line pharmacological treatment for ADHD. This study aims to explore the lived experience of children with FASD taking MPH and their caregivers to adapt prescribing modalities by considering different ways to administer the drugs. We hope to improve the therapeutic alliance between the children and their caregivers by gaining an insiders' view of the medication perception. Semi-structured interviews with children and their caregivers were conducted in this qualitative study. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data were analysed using interpretative phenomenological analysis. We conducted 16 semi-structured interviews: 8 with the children aged 7-12, 5 boys and 3 girls and 8 with their caregivers. The analysis showed that inadequate palatability and capsule form experiences were the leading causes of children's non-adherence to the treatment. MPH appeared to be a valuable aid for caregivers even if they had concerns about its potential toxicity. However, it is necessary to identify caregivers' expectations concerning MPH to adapt the prescription in terms of choice of specialty and intake modalities. Regular support was required to reduce caregivers' fears of dependence, personality transformation and long-term adverse effects. Information on palatability should be given when prescribing MPH to children with ADHD as well as its possible side effects or toxicity. It highlights the need for further studies of the experience of palatability of drugs prescribed to children. When prescribing a treatment, children should be more involved in medical counselling and it is necessary to understand the child's perspectives to co-construct common representations for better therapeutical adherence.
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Affiliation(s)
- Clémentine Morin
- Pôle de Santé Mentale, CIC-EC 1410, CHU de La Réunion, BP350, Saint-Pierre, La Réunion, France
- UFR Des Sciences Médicales, Université de Bordeaux, Bordeaux, France
| | - Bérénice Doray
- Pôle de Santé Mentale, CIC-EC 1410, CHU de La Réunion, BP350, Saint-Pierre, La Réunion, France
- Faculté de Santé, Université de La Réunion, Saint-Denis, France
| | - Cécilia Dumar
- Pôle de Santé Mentale, CIC-EC 1410, CHU de La Réunion, BP350, Saint-Pierre, La Réunion, France
| | - Jude Balit
- Department of Epidemiology, Biostatistics, and Public Health, McGill University, Montreal, QC, Canada
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
| | - Nicolas Bouscaren
- Pôle de Santé Mentale, CIC-EC 1410, CHU de La Réunion, BP350, Saint-Pierre, La Réunion, France
| | - Michel Spodenkiewicz
- Pôle de Santé Mentale, CIC-EC 1410, CHU de La Réunion, BP350, Saint-Pierre, La Réunion, France.
- Faculté de Santé, Université de La Réunion, Saint-Denis, France.
- Inserm U1018, CESP, Le Kremlin-Bicêtre, France.
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada.
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The Self of Adolescents with Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder: A Qualitative Study. J Autism Dev Disord 2021; 51:1668-1677. [PMID: 32839893 PMCID: PMC8084812 DOI: 10.1007/s10803-020-04653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Self-development is a central developmental issue in adolescence, there are few studies describing the experiences related to the self in adolescents with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). We conducted semi-structural interviews with 14 adolescents with ASD and three with ADHD to describe the self. As a result of inductive continuous comparison analysis, three concepts "Interest in self and self-realization", "Intentionality and self-transformation", "Unrealized/unnoticed self" were generated. It was suggested that the characteristic perceptions may tend to have difficulty realizing subjective selves.Otherwise, most adolescents realized various sense of self through interaction with others. Nurses should know adolescents' inner world and share their emotions related to their self-recognition in order to provide care that meets important youth developmental needs.
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Mundal I, Laake P, Mezzich J, Bjørkly SK, Lara-Cabrera ML. Assessment of the Quality of Life in Parents of Children With ADHD: Validation of the Multicultural Quality of Life Index in Norwegian Pediatric Mental Health Settings. Front Psychol 2021; 12:638006. [PMID: 33613407 PMCID: PMC7894072 DOI: 10.3389/fpsyg.2021.638006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background: The brief generic Multicultural Quality of Life Index (MQLI) is a culturally informed self-report 10-item questionnaire used to measure health-related quality of life (QoL). QoL is an important outcome measure in guiding healthcare and is held as a substantial parameter to evaluate the effectiveness of healthcare. Attention Deficit Hyperactivity Disorder (ADHD) in children might negatively influence the parents' QoL. Having a validated questionnaire to measure QoL for this population will therefore be a vital first step in guiding healthcare for parents of children with ADHD. We aimed to examine the reliability and validity of the Norwegian version of the MQLI in a sample of parents of children with ADHD. Methods: In a cross-sectional study, 128 parents of children with ADHD were recruited from four outpatient clinics within the Child and Adolescents Mental Health Services (CAMHS) in Norway. They completed the MQLI along with an alternative well-being scale, the Five-item World Health Organization Well-being Index (WHO-5), and a form including demographic variables. Reliability and validity of the MQLI were examined. We conducted a factor analysis and calculated internal consistency and the correlation between the MQLI and the WHO-5. Results: Factor analysis of the parents reported MQLI yielded a one-factor solution. For the MQLI, Cronbach's alpha was 0.73. The correlation between the two measures of MQLI and WHO-5 was high (r = 0.84), reflecting convergent validity since the association between the two measures was strong. Conclusion: Results from this study support the reliability and validity of the Norwegian version of the MQLI for assessment of quality of life in parents of children with ADHD with good psychometric properties. Study findings support the use of the questionnaire in CAMHS.
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Affiliation(s)
- Ingunn Mundal
- Department of Health and Social Sciences, Molde University College, Molde, Norway
- Department of Psychiatry, Kristiansund Community Mental Health Centre, Møre og Romsdal Hospital Trust, Kristiansund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petter Laake
- Department of Health and Social Sciences, Molde University College, Molde, Norway
- Department of Biostatistics, Oslo Centre for Statistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Juan Mezzich
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
- San Fernando School of Medicine, San Marcos National University, Lima, Peru
- International College of Person-Centered Medicine, New York, NY, United States
| | - Stål K. Bjørkly
- Department of Health and Social Sciences, Molde University College, Molde, Norway
- Centre for Forensic Research, Oslo University Hospital, Oslo, Norway
| | - Mariela Loreto Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Tiller Community Mental Health Centre, St. Olav’s University Hospital, Trondheim, Norway
- Division of Mental Health, Department of Research and Development, St Olav’s University Hospital, Trondheim, Norway
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Dauman N, Haza M, Erlandsson S. Liberating parents from guilt: a grounded theory study of parents' internet communities for the recognition of ADHD. Int J Qual Stud Health Well-being 2019; 14:1564520. [PMID: 30696381 PMCID: PMC6352942 DOI: 10.1080/17482631.2018.1564520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study presents a qualitative analysis of information posted on the Internet by two communities of French parents promoting the recognition of ADHD in the context of current health and school practices. METHOD Grounded Theory (Strauss & Corbin's approach) was applied to the posted messages, with the aim to discover the main concern and common theme through a constant comparison analysis. RESULTS Liberating parents from feeling responsible for their child's misconduct was found to be the core category. From this perspective, we account for the commitment of the digital communities to formalize the child's conduct as a consequence of a neurodevelopmental disorder. This approach helps to account for the promotion of behavioural expertise and conditioning strategies (e.g., positive reinforcement) for handling the child's so-called disorder as appropriate parental responses. Giving evidence for parenting struggles was the third main concern of the communities, in the face of perceived skepticism from professionals towards ADHD as a medical condition. CONCLUSIONS By using examples from countries that are found to have a more pro-medical approach to ADHD, the communities aim at improving such medical practices in France. Issues surrounding the claim that ADHD would require a specific style of parenting are also discussed.
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Affiliation(s)
- Nicolas Dauman
- Department of Psychology, University of Poitiers, Poitiers, France
| | - Marion Haza
- Department of Psychology, University of Poitiers, Poitiers, France
| | - Soly Erlandsson
- Centre for Child and Youth Studies, University West, Trollhättan, Sweden
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Leitch S, Sciberras E, Post B, Gerner B, Rinehart N, Nicholson JM, Evans S. Experience of stress in parents of children with ADHD: A qualitative study. Int J Qual Stud Health Well-being 2019; 14:1690091. [PMID: 31713473 PMCID: PMC6853214 DOI: 10.1080/17482631.2019.1690091] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/01/2022] Open
Abstract
Purpose: Qualitative research aimed at understanding the stress of parents of children with ADHD is limited and few interventions have been designed to directly target their stress. The study aim was to explore the stress of parents of children with ADHD using qualitative methodology.Methods: Thirteen parents of children with ADHD participated in two focus groups. Open-ended questions explored parents' experiences of stress. Focus groups were recorded, transcribed, and coded using thematic analysis. Parents also completed the Parenting Stress Index-Short Form.Results: Four primary themes were identified: The child's behaviour feels like a "wrecking ball"; Coping with the "war at home"; A divided family: "relationships don't survive"; and Craving support: "it's goddamn hard work". Five of eleven participants who completed the PSI-SF scored in the clinically significant range indicating levels of stress that require professional support.Conclusions: Parents attribute their high stress to their children's behaviour, unmet needs for support, and social stigma. Parents request support to enable them to cope and appear to represent a clinical population who require mental health care and support themselves. Future interventions directly targeting the stress of parents of children with ADHD may provide wide-ranging benefits for their children and families.
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Affiliation(s)
- Sophie Leitch
- School of Psychology, Deakin University, Burwood, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Burwood, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Brittany Post
- School of Psychology, Deakin University, Burwood, Australia
| | - Bibi Gerner
- School of Psychology, Deakin University, Burwood, Australia
| | | | - Jan M. Nicholson
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Burwood, Australia
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Andersson Frondelius I, Ranjbar V, Danielsson L. Adolescents' experiences of being diagnosed with attention deficit hyperactivity disorder: a phenomenological study conducted in Sweden. BMJ Open 2019; 9:e031570. [PMID: 31455717 PMCID: PMC6720151 DOI: 10.1136/bmjopen-2019-031570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To explore adolescents' experiences of being diagnosed with Attention deficit hyperactivity disorder (ADHD). DESIGN Qualitative interview study, using a phenomenological framework and analysis. SETTING The children's clinic of a specialised out-care hospital located in a multicultural area of a Swedish city. PARTICIPANTS 13 adolescents, 7 boys and 6 girls between 14 and 19 years old, who had been diagnosed with ADHD. RESULTS The participants' experience of being diagnosed with ADHD was interpreted as a process of understanding oneself as being different, for better or worse, like many others. The participants sought acceptance and a sense of normality, while developing an understanding of both the positive and the negative sides of their ADHD traits. These two sides of a coin were inter-related parts of themselves and were shared by many others, which increased their acceptance. Three themes described phases of the process: struggling with vulnerability, responding to a label and manoeuvring social life. CONCLUSION The results add to previous research, illuminating that the adolescents tried to make sense of both the uniqueness and the vulnerability of the ADHD diagnosis. The findings can be useful for healthcare professionals, in reflecting on the complexity of ADHD and on the adolescents' expectations.
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Affiliation(s)
| | | | - Louise Danielsson
- Research Unit, Angered Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations. Clin Child Fam Psychol Rev 2019; 21:57-93. [PMID: 29079900 DOI: 10.1007/s10567-017-0245-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research on children and parents' experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7-30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219-252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.
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Managing Complexity: Exploring Decision Making on Medication by Young Adults with ADHD. PHARMACY 2018; 6:pharmacy6020033. [PMID: 29671768 PMCID: PMC6025481 DOI: 10.3390/pharmacy6020033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022] Open
Abstract
Attention-deficit hyperactivity disorder (ADHD) causes difficulties with hyperactivity, impulsivity and inattention. Treatment of ADHD includes both medication and non-pharmacological options. Knowledge of treatment preferences by young adults with ADHD is sparse. The objective of this study was to explore the beliefs and experiences of young adults with ADHD related to their medication treatment decisions. Data were collected in Denmark in 2016 through a focus group and individual in-depth interviews. Conventional content analysis was used. Ten young adults with ADHD (22-to 29-year-old) participated. Three major themes were identified: (1) the patient’s right to choose concerning ADHD medicine; (2) the patient’s decision of whether or not to treat ADHD with medication; and (3) factors affecting the patient’s decision on whether to take ADHD medication or not. The latter theme contained 15 factors, which were distributed across three levels: individual, between-individuals, and societal. The dominant factors were increasing quality of life and improving oneself e.g., improving social skills. For counselling at the pharmacy and by prescribers, it is important to be aware of the different factors that affect young adult patients’ decisions on whether to take ADHD medication or not. This knowledge will aid to understand reasons for non-adherence and to determine appropriate treatment for the individual patient.
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Moore DA, Russell AE, Arnell S, Ford TJ. Educators' experiences of managing students with ADHD: a qualitative study. Child Care Health Dev 2017; 43:489-498. [PMID: 28233330 DOI: 10.1111/cch.12448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/20/2016] [Accepted: 01/08/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The symptoms of attention-deficit/hyperactivity disorder are associated with difficulty coping with the social, behavioural and academic components of school. Compared with medication and other non-pharmacological treatment, there is less evidence relating to school-based interventions to support children with ADHD. There is additionally an absence of any research focused on the experiences and practices of educators in the UK around how they work with children who are inattentive, impulsive and hyperactive. METHODS Forty-two educational practitioners from primary, secondary and alternate provision schools in the UK participated in focus groups or individual interviews that explored (1) their experiences of managing students with ADHD in the classroom and (2) factors that helped and hindered them in this endeavour. Transcripts were analysed using thematic analysis. RESULTS Analysis identified six themes: broad strategies, student-centred, inclusive strategies, labelling, medication and relationships. Participants' experiences of managing students with ADHD drew upon a wide range of strategies that typically involved responding to individual needs in an inclusive manner, so individuals with ADHD could access the classroom with their peers. Participants spoke about three factors that helped and hindered managing students with ADHD. Labelling of students with ADHD was reported, with the negative aspects of labelling, such as stigmatization, affecting the classroom. Educators reported mixed experiences regarding the helpfulness of medication; where helpful, it allowed the use of strategies in the classroom. Although students with ADHD were described as having rollercoaster relationships, positive relationships were considered key to the support of children with these difficulties. CONCLUSIONS This study suggests that factors such as attitudes towards ADHD, relationships experienced by students with ADHD and other treatments being delivered need to be carefully considered before strategies are put in place in the classroom. This study supports the need for further work on the implementation of evidence-based school interventions for ADHD.
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Affiliation(s)
- D A Moore
- University of Exeter Medical School, Exeter, UK
| | - A E Russell
- University of Exeter Medical School, Exeter, UK
| | - S Arnell
- Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - T J Ford
- University of Exeter Medical School, Exeter, UK
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